WESTLAKE VILLAGE, Calif.—A measure of socioeconomic distress has been found to be an independent predictor of 90-day mortality in surgical patients with sepsis, according to data presented at the 2023 annual meeting of the Surgical Infection Society.
The retrospective analysis of sepsis patients admitted to the surgical ICU at The Ohio State University Wexner Medical Center, in Columbus, showed that high scores on the Area Deprivation Index (ADI) were associated with nearly 40% greater odds of dying within 90 days. Given these results, the investigators emphasized the need for actionable interventions based on socioeconomic factors to improve patient outcomes.
“These findings highlight the importance of considering socioeconomic factors as a host factor in sepsis care,” said Whitney Kellet, MD, a general surgery resident at Wexner Medical Center. “There needs to be collaboration between public health and medical professionals to provide real, actionable intervention strategies to address these factors.”
As Dr. Kellet explained, measures of community distress have shown mixed results regarding their association with health outcomes in critically ill patients. However, the ADI has emerged as a more clinically relevant socioeconomic metric.
“The ADI is more geographically specific than other polysocial metrics and considers factors such as income, housing and education, as well as more nuanced factors that reflect the day-to-day experiences of patients and their interactions with the healthcare system,” Dr. Kellet said.
For this study, Dr. Kellet and colleagues calculated the ADI using patients’ addresses, which they stratified into high ADI (high deprivation) and control ADI groups. The primary outcome of the study was 90-day mortality.
As Dr. Kellet reported, a high ADI was associated with significantly increased odds of 90-day mortality in patients with surgical sepsis (odds ratio, 1.39±0.24; 95% CI, 1.09-2.07). This association remained significant after controlling for other demographic and clinical characteristics.
“Interestingly, the effect of high ADI on mortality risk became more pronounced as time passed since the initial hospital admission, suggesting that the impact of socioeconomic factors on patient outcomes may extend beyond the immediate care experience,” Dr. Kellet said.
According to Dr. Kellet, understanding the specific components of the ADI that contribute to its predictive power is crucial for developing effective intervention strategies. The researchers are collaborating with the Health Outcomes and Policy Evaluation Studies group and the public health department to analyze the source data further and identify the specific factors within the ADI that have the most significant impact on patient outcomes.
Discussant of the abstract, Ori D. Rotstein, MD, a professor and the associate chair of the Department of Surgery at the University of Toronto, praised the study for addressing the crucial aspect of social determinants of health and their impact on patient outcomes. Dr. Rotstein also raised several questions and points for further consideration.
According to Dr. Rotstein, many studies separate patients into quintiles based on the ADI, while this study used a binary approach (defining a high ADI as a score >85 vs. the control group at <85). He suggested that using quintiles might have shown a more significant difference between high- and low-ADI groups, potentially underestimating the impact of the ADI on patient outcomes.
Dr. Rotstein also asked about the insurance status of the study population and whether it might have contributed to the observed outcomes, as it does in other studies.
With respect to the transfer status of patients, Dr. Rotstein noted that it is not immediately apparent why patients transferred from another hospital would have poorer outcomes. He asked whether there were delays in treatment or other factors that might explain this finding.
Finally, Dr. Rotstein addressed the controversial issue of unconscious biases in patient care and asked for advice about ensuring equitable care.
“Although care for septic patients is largely standardized in tertiary care hospitals, studies have documented differential care based on factors such as race, income and background,” Dr. Rotstein said. “How can healthcare providers ensure equitable care and measure outcomes in their institutions?”
Dr. Kellet advised caution when using measures like the ADI: “We must be very careful about incorporating measures like this into our practice,” he responded. “We could end up adding to our implicit bias, which is the opposite of what we want to do.”
Dr. Kellet noted that he is interested in examining both transfer and insurance status in future analyses.